Topic Contents

Discusses normal growth and development of children ages 2 to 5. Covers physical growth, language skills, toilet training, and eating and sleeping habits. Also discusses how kids think and manage their feelings. Includes info on routine medical visits.

Growth and Development, Ages 2 to 5 Years

Topic Overview

How does a child grow and develop between the ages of 2 and 5?

The ages between 2 and 5 are often called the preschool years.
During these years, children change from clumsy toddlers into lively explorers
of their world. A child develops in these main areas:

Physical development. In these years, a
child becomes stronger and starts to look longer and leaner.

Cognitive development. A child this age
makes great strides in being able to think and reason. In these years, children
learn their letters, counting, and colors.

Emotional and social development. Between the ages of 2 and 5, children gradually learn how to manage
their feelings. By age 5, friends become important.

Language. By age 2, most children can say at least 50 words. By
age 5, a child may know thousands of words and be able to carry on
conversations and tell stories.

Sensory and motor development. By age 2,
most children can walk up stairs one at a time, kick a ball, and draw simple
strokes with a pencil. By age 5, most can dress and undress themselves and write some lowercase and capital
letters.

Each child
grows and gains skills at his or her own pace. It is common for a child to be
ahead in one area, such as language, but a little behind in another.

Learning what is normal for children this age can help you spot problems
early or feel better about how your child is doing.

Why are routine medical visits needed?

Routine checkups usually are scheduled several times during ages 2 to 5. These routine checkups
are called well-child visits. They are important to check for problems
and to make sure that your child is growing and developing as expected.

Weigh and measure your child to
see how he or she compares to other children of the same age.

Ask questions about your child's behavior and your family.

Ask about your child's favorite activities or friends.

Well-child visits are a good time to talk with your doctor about any
concerns you have about your child's health, growth, or behavior. Between
visits, write down any questions you want to ask the doctor next time.

When should you call a doctor?

Call your doctor
anytime you have a concern about your child's physical or emotional health. Be
sure to call if your child:

Is not reaching developmental milestones as expected.

Is not growing at a steady pace.

Has lost skills he or she used to have, such as talking or
running.

Is violent or abusive.

Doesn't seem to be doing well, even though you can't pinpoint
what makes you uneasy.

How can you help your child during these years?

It's important to learn about some of the behaviors you can expect during
these years of rapid change. Temper tantrums, thumb-sucking, and nightmares are
common issues in children this age. Knowing what to expect can help you to be
patient and get through the stressful moments.

The best thing you
can do for your child is to show your love and affection. But there are also
many other ways you can help your preschooler grow and learn.

Make time for your child to be active. Limit TV and computer time to 2
hours a day or less.

Read and talk to your child. This helps children learn
language and opens them up to new ideas.

Help your child get enough rest. Between the ages of 2 and 5,
children need about 11 to 13 hours of sleep each day.

Help your child play with other children.
Preschool or play groups can be a great way for children to learn to interact.

Teach skills, such as how to get dressed and how to use the
toilet.

Set limits that help your child feel safe and secure but that
also allow your child to explore.

Raising a preschooler can be challenging. What works or
is right for a 2-year-old may not be right for a 5-year-old. Taking a parenting
class can help you learn how to deal with issues as they arise. To find a class, ask your child's doctor or call a local hospital.

What to Expect

General development between ages 2 and 5 years

Children grow in natural, predictable steps, moving from one milestone to the next. You will see gains in five major areas.

Emotional and social development begins at age 2 with
excitement about being around other children. But most children at
this age play near each other rather than with each other (parallel play). By age 5, most children seek and enjoy friendships.

Physical development slows down from
the rapid growth during infancy. From age 2 through age 5, most children
gain about
3 lb (1.5 kg) to
5 lb (2.5 kg) a year and grow about
3 in. (8 cm) a year.

Cognitive development, or thinking and
reasoning skills, progresses from a simple to a more complex understanding of
time, letters, counting, and colors. Children are able to follow increasingly
more detailed commands.

Language develops rapidly between ages
2 and 5. By age 3, children can speak at
least 200 words and can follow two-part directions, such as "Wash your face and
put your shoes away." Most
5-year-olds can carry on a conversation.

Sensory and motor skills become more
refined, from being able to walk up stairs, kick a ball, and draw simple
strokes to being able to do basic tumbling and draw rough figures of people and other
recognizable objects.

Know their address and phone number, most letters of the
alphabet, how to count up to 10, and basic concepts of time.

Like to please others and have friends. But it is normal for
children this age to sometimes act unkindly.

Can carry on conversations and use more advanced grammar, such as
the future tense.

Can hop on one foot, somersault, and possibly skip. Most
5-year-olds can dress and undress themselves.

Common Concerns

It's common for parents to have questions about their child's sleep, safety,
toilet training, and difficult emotions and behavior.

Sleeping

Preschool children need about 11 to 13 hours of sleep each day. Your child may go through
phases when he or she resists resting.

To help foster good sleep habits, you can:

Set bedtime routines. Do things in
the same order each night so that your child understands what to expect and
associates these steps with going to sleep.

Handle sleep disturbances. Sometimes young children wake up and want attention or
reassurance. Keep your response the same each time your child wakes up. If you go into
your child's room, make the visit quick.

Help prevent nightmares.
Preschool-age children's rich fantasy lives and active imaginations make them
prone to nightmares. These tend to occur toward the end of the night or very
early in the morning. You can help prevent nightmares by controlling what your child watches on TV. Also, encourage your child to talk about daily events to help him or her not feel confused or afraid.

Manage night terrors. Night terrors
are different from nightmares because the child remains asleep and doesn't remember the episode in the morning. Night terrors
tend to occur about 3 to 5 hours after the child goes to sleep. Your child may cry intensely and may be short of breath. Do not try to wake a child during
a night terror. Instead, reassure your child and hold him or her to prevent
injury.

Safety

To
help keep your child safe, it's very important to be aware of your
child's abilities and the environment, whether it is the home, a playground, or
a public place. These abilities change as your child grows and gains new skills.

Behavior

Children ages 2 to 5 have many
intense emotions that they do not fully understand. As a result, expect your
young child to not always listen to you. Be patient, and do your best to be
consistent about setting limits to avoid some common
issues. These may include:

Temper tantrums. These emotional
outbursts are perhaps the biggest behavior challenge for this age group. Many
1- to 4-year-olds have
temper tantrums at least once a week. For more information, including help on how to respond to
tantrums, see the topic
Temper Tantrums.

Thumb-sucking. Thumb-sucking in children
younger than 4 years of age is not usually a problem. Most children stop sucking
their thumbs sometime between ages 3 and 6. But children who suck their thumbs often or with a lot
of force after the age of 3 or 4 may develop emotional, dental, or speech
problems. For more information, see the topic
Thumb-Sucking.

Breath-holding spells. These are periods
when young children stop breathing, often causing them to pass out (lose consciousness).
Breath-holding spells typically happen when a young
child is angry, frustrated, in pain, or afraid. The spell is a reflex, not a
deliberate behavior. For more information, see the topic
Breath-Holding Spells.

Aggression. Some preschool children
become aggressive and may hurt other children.
Hitting,
biting, pushing, and shouting are all common forms of
aggression. Children's aggressive behavior usually is a normal variation of
their
temperament. Parents
can encourage self-control by teaching positive
behavior and how to channel feelings into words.
For example:

Help your child calm down. Then you can talk about better ways
to handle feelings.

Don't expect changes in behavior right away. It takes time, repetition, and supportive comments for a child to learn.

Toilet training

Each child learns to use the toilet at his or her own pace. Most children are ready for
toilet training when they are between 22 and 30 months
of age.

It can be hard to know
when to start toilet training. Your child's physical and emotional readiness is the most important aspect of the timing. You and your child will likely become frustrated if
you try toilet training before your child is ready.

Promoting Healthy Growth and Development

You can help your child grow by showing love and affection, by talking with and
reading to your child, and by letting your child play. It's also important to set boundaries and
limits.

Physical development

Offer plenty of opportunities for
exercise. Going to the playground, joining a
gymnastics or dance class, or simply running races in your backyard allows your
child to release excess energy and encourages new physical skills. For more information, see the topic Physical Activity for Children and Teens.

Cognitive development

Encourage safe exploration. Children who explore learn to
master new skills and solve problems. Offer a variety of things to play with,
read, create, and build. Take basic measures to minimize risks. For more information about preventing
accidents and injuries, see the topic
Health and Safety, Ages 2 to 5 Years.

Encourage a sense of security. This sense of trust
lays the foundation for learning, social skills, adaptability, and emotional
development. Your child is more
likely to feel safe and secure if you are dependable, consistent, respectful,
and responsive. Secure children also keep and strengthen their attachment to their
parents.

Emotional and social development

Provide peer contact. Playing with other children
even 1 day a week gives children opportunities to practice and develop
important social, emotional, and language skills.

Promote self-control. Children need guidance, clear
limits, and patient parents during this time of behavioral and emotional
struggles. Help your child by modeling and teaching proper behavior. Time-outs can help, when they are used properly
and sparingly. Encourage your child to think about the feelings of other people to develop
empathy.

Help your child build self-esteem. Parents have the greatest influence
on a child's belief about himself or herself. Let your child know that he
or she belongs, is doing well, and is contributing.

Sensory and motor development

Provide a variety of experiences and play environments. Schedule time each day for either indoor or outdoor
physical activity, such as dancing or going to a playground. These activities improve coordination and other large muscle skills. Fine motor
skills develop through things such as art projects (like painting or using scissors) and playing musical instruments.

Nurturing your relationship with your child

Your relationship with your child will constantly change
as your child gains new skills and
develops independence. You can help your child through
each stage by looking at your relationship from time to time. Ask
yourself:

What do I like most about my child?

What could be triggering problem behavior? Are any of these new
triggers?

What new skills has my child learned within the past 3 months?
2 months? 1 month?

What tasks can I encourage my child to do for himself or herself?
How can I encourage him or her?

When am I happy about how I treat my child?

What don't I like about some of our interactions? When do these
episodes tend to occur?

If you are the parent or caregiver of children, it is also important
for you to:

Learn healthy techniques to resolve conflicts and manage
stress. For more information, see the topic
Stress Management.

Ask for help when you need it. Call a family member or friend to
give you a break if you feel overwhelmed. Find community resources to help you with child care or other services that you need. Call a
doctor or local hospital for a place to start. Some communities have respite
care facilities for children. They provide temporary child care during times
when you need a break.

Seek help if you think you have a problem with alcohol,
drugs, anger,
depression, stress, or other issues that affect your
mental health.

Getting ready for kindergarten

Most children start kindergarten around age 4½ to 6 years.

It can be hard to know when your child is ready for school, but your local elementary school or preschool can help. Attending preschool or play groups can be a great way for children to build new skills and learn to interact with others.

Some of the tasks and behaviors that show that a child is ready for kindergarten are the following:

Your child can keep hands to himself or herself while in line; sit and pay attention for at least 5 minutes; help with clean-up activities, such as putting away toys; use words for frustration rather than acting out; work and play with other children in small groups; talk with other children and adults.

Your child can hold a pencil correctly, cut with scissors, do what the teacher asks, get dressed, and use the bathroom without help.

Your child knows the alphabet; can write his or her first name; may recognize some printed words; can count from 1 to 20 and name the colors.

When to Call a Doctor

Although your child grows at
his or her own pace, be aware of signs of a
developmental delay. The earlier you identify a delay,
the better chance you have of getting the right treatment for your child that
can prevent or minimize long-term problems.

In general, talk to a
doctor anytime your child:

Does not seem to be reaching developmental milestones as
expected.

Is not growing at a steady pace. Each year between ages 2 and 5
years, expect your child to gain about
3 lb (1.5 kg) to
5 lb (2.5 kg) and grow as much as
3 in. (7.6 cm). Although your
child's height and weight are measured at routine
well-child exams, call your doctor if your child's
growth pattern concerns you in between these visits.

Is not able to do some of the things he or she used to do, such
as talking or running.

Makes you so angry or frustrated that you are
worried about what you might do next.

Acts overly aggressive, violent, or verbally abusive.

Does not seem to be doing well, even though you can't pinpoint
what makes you uneasy. Friends and other caregivers may also be
concerned.

Routine Checkups

Routine well-child visits allow your
child's doctor to keep a close eye on your child's general health and
development. You also can discuss any concerns you have at these appointments. It may help you to go with a
prepared
list of questions(What is a PDF document?).

Physical exam

The doctor typically
will:

Measure your child's weight and height. These measurements are
plotted on a
growth chart to see how your child compares
to other children of the same age. This chart is updated at each routine exam to document the child's growth pattern. You can check your child's
body mass index (BMI) at home to estimate whether your
child is at a healthy weight for his or her height, age, and gender. To find
out your child's BMI, use this
Interactive Tool: What Is Your Child's BMI?

Routine screening tests for
hearing and vision take place during the preschool years. A
specialist may do formal tests if your child's screening results are poor or if
there are any developmental concerns at ages 2 to 5.

Mental and emotional health

The doctor
will talk with both you and your child to get a sense of your child's mental,
emotional, and social development. Questions typically cover:

Whether any noticeable behavioral changes have occurred.

Your child's and family's general well-being. The doctor also
observes how you and your child interact.

How your child reacts to strangers.

How your child plays and interacts with peers.

Whether you have any concerns about issues such as
toilet training, preschool, or troubling
behaviors.

Your child's language, hearing, and social skills. The doctor
asks your child questions to briefly assess these and related
developmental issues. For example, the doctor may ask your child about his or
her favorite activities and the names of his or her friends.

In addition to the above assessments, doctors usually ask
questions specific to a child's age.

Caring for your child's teeth is also important for your child's health. Schedule regular visits every 6 months or as your dentist recommends.
For more information, see the topic Basic Dental Care.

Other Places To Get Help

Organizations

American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL 60007-1098

Phone:

(847) 434-4000

Fax:

(847) 434-8000

Web Address:

www.aap.org

The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.

Bright Futures

P.O. Box 571272

Washington, DC 20057-1272

Phone:

(202) 784-9770

Fax:

(202) 784-9777

Web Address:

www.brightfutures.org

The Bright Futures Web site offers current information
about health promotion and health care needs of infants, children, teens,
families, and communities. Bright Futures is sponsored by the National Center
for Education in Maternal and Child Health at Georgetown University.

KidsHealth for Parents, Children, and
Teens

Nemours Home Office

10140 Centurion Parkway

Jacksonville, FL 32256

Phone:

(904) 697-4100

Web Address:

www.kidshealth.org

This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.

National Institute of Child Health and Human
Development

P.O. Box 3006

Rockville, MD 20847

Phone:

1-800-370-2943

Fax:

1-866-760-5947 toll-free

TDD:

1-888-320-6942

Email:

NICHDInformationResourceCenter@mail.nih.gov

Web Address:

www.nichd.nih.gov

The National Institute of Child Health and Human
Development (NICHD) is part of the U.S. National Institutes of Health. The
NICHD conducts and supports research related to the health of children, adults,
and families. NICHD has information on its Web site about many health topics.
And you can send specific requests to information specialists.

U.S. Consumer Product Safety
Commission

4330 East West Highway

Bethesda, MD 20814

Phone:

1-800-638-2772 consumer hotline(301) 504-7923

TDD:

(301) 595-7054

Web Address:

www.cpsc.gov

The Consumer Product Safety Commission (CPSC) is an
independent federal regulatory agency. CPSC seeks to protect consumers and families from dangerous products that can injure people, especially children. CPSC develops safety standards and informs the public about product hazards and recalls. You can call
their toll-free number or email them to report unsafe products.

Committee on Nutrition, American Academy of Pediatrics (2001, reaffirmed 2006). The use and misuse of fruit juice in pediatrics. Pediatrics, 107(5): 1210–1213. Also available online: http://pediatrics.aappublications.org/content/107/5/1210.full.

Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics (1998, reaffirmed 2012). Guidance for effective discipline. Pediatrics, 101(4): 723–728. [Erratum in Pediatrics, 101(2): 433.] Also available online: http://pediatrics.aappublications.org/content/130/2/e467.full.

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How this information was developed to help you make better health decisions.